Cardiac Ablative Technologies
Device technologies to treat cardiac arrhythmia continue to advance at a rapid pace; this is a highly competitive field with numerous corporate powerhouses playing significant roles. The primary goals for treatment of arrhythmia are to: (1) alleviate symp
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29
Boaz Avitall and Arthur Kalinski
Abstract
Device technologies to treat cardiac arrhythmia continue to advance at a rapid pace; this is a highly competitive field with numerous corporate powerhouses playing significant roles. The primary goals for treatment of arrhythmia are to: (1) alleviate symptoms and improve an individual’s quality of life; (2) prolong the patient’s life by preventing complications such as ventricular tachycardia/fibrillation, syncope, and/or stroke; and (3) reduce an individual’s dependency on pharmacologic therapies that often carry significant side effects. Pharmacologic treatment has been the mainstay for management of most cardiac arrhythmias, although in recent years implantable devices and ablation have become increasingly more important. In this chapter we review several ablation technologies that are in current use as well as others that are being developed. This review contains descriptions of: (1) various energy sources; (2) the mechanisms of action for lesion formation; (3) required power sources; (4) the variety of catheters that can be used to apply these therapies; (5) potential treatment complications; and (6) the recent sensor technologies that are being developed to improve therapeutic efficacy and/or minimize complications. Keywords
Radiofrequency • Microwave • Cryotherapy • Cryoablation • Laser ablation • Ultrasound ablation • Thermal therapy • Arrhythmia • Atrial fibrillation • Electrophysiology
29.1
Introduction
As technology for percutaneous catheter interventions evolved, the result has been the design of specialized catheters for cardiac ablative therapies. These specialized catheters and their required energy sources have employed a variety of approaches, each with its advantages and disadvantages. Importantly, this variety of catheters and approaches has broadened the types of arrhythmia that can be treated by interventional approaches and improved their efficiency and
B. Avitall, MD, PhD, FACC, FHRS (*) • A. Kalinski, BS Division of Cardiology, Department of Medicine, University of Illinois at Chicago, 840 S. Wood St., MC 15, Chicago, IL 60612, USA e-mail: [email protected]
efficacy. In this chapter, we will review the underlying ablative mechanisms for current leading technologies in catheter ablation; we will also highlight the current applications of these technologies in the clinical setting. The range of the normal human resting sinus heart rate is 50–90 beats per minute (bpm); most average healthy individuals have resting rates in the 60–70 bpm range. Disturbances of cardiac impulse formation and/or transmission comprise the principal mechanisms, causing abnormalities of heart rhythm. In basic terms, these abnormalities are classified as being either brady- or tachy-arrhythmias. Today, in North America alone, it is estimated that there are over five million individuals who require treatment for some form of arrhythmia. Arrhythmias can occur at any age, but they become increasingly more prevalent as a function of age. Therefore, as our current populat
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